| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1206 |
Topical application of fluoride varnish |
571 |
549 |
$16K |
| D1120 |
Prophylaxis - child |
565 |
546 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
232 |
224 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
239 |
232 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
29 |
12 |
$3K |
| D9999 |
Unspecified adjunctive procedure, by report |
66 |
64 |
$2K |
| D0272 |
Bitewings - two radiographic images |
160 |
156 |
$2K |
| D9630 |
|
27 |
25 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
15 |
13 |
$420.00 |
| D0220 |
Intraoral - periapical first radiographic image |
13 |
13 |
$117.26 |
| D0230 |
Intraoral - periapical each additional radiographic image |
13 |
12 |
$30.81 |